Palliative Care from the Beginning of Treatment for Advanced Pancreatic Cancer
Abstract
Palliative care ought to be offered at the initiation of treatment for people who are diagnosed with pancreatic cancer, given the poor relative survival rate and the intractable symptom profile of those who have this life-limiting disease. In this article, we argue that palliative treatment of people with pancreatic cancer is not found in extending survival, but rather, in promoting quality of life. This argument is made by reviewing the literature on the state of palliative care in pancreatic cancer and by summarizing key studies presented at the "2010 ASCO Gastrointestinal Cancers Symposium" held in Orlando, FL, USA on January 22-24, 2010. The studies discussed here include: i) a study of a random sample of 564 patients with pancreatic cancer that found that the symptom cluster of fatigue and pain predicted survival (Abstract #265); ii) a retrospective study of 108 patients that identified anticoagulation therapy in those who developed portal vein thrombosis prolonged survival (Abstract #143); iii) a double-blind randomized control trial of 50 patients with gastrointestinal cancers who were cachexic in which a thalidomide-olanzapine-megasterol acetate combination attenuated the effects of cancer-anorexia-cachexia syndrome (Abstract #209); iv) a retrospective study on the role of adjuvant chemoradiation and chemotherapy in the treatment of advanced pancreatic cancer (Abstract #230); and v) the benefit of chemotherapy in patients with metastatic pancreatic cancer 80-year-old or more (Abstract #232). Based on the results presented at the meeting, we believe that the discussion of palliative care in the treatment of advanced pancreatic cancer must not conflate the notion of increased survival with increased quality of life, the latter of which is part and parcel of the goal of palliative care. We believe that future study on the effect on quality of life of early palliative-care interventions among people with pancreatic cancer is necessary.
Image: Yale University School of Nursing. New Haven, CT, USA.
Downloads
References
Horner MJ, Ries LAG, Krapcho M, Neyman N, Aminou R, Howlader N, et al (eds). SEER Cancer Statistics Review, 1975-2006, National Cancer Institute. Bethesda, MD.] (FULL TEXT: http://seer.cancer.gov/csr/1975_2006/, based on November 2008 SEER data submission, posted to the SEER web site, 2009. (FULL TEXT: http://seer.cancer.gov/csr/1975_2006/index.html)
Lau MK, Davila JA, Shaib YH. Incidence and Survival of Pancreatic Head and Body and Tail Cancers: A Population-Based Study in the United States. Pancreas 2009 Nov 16. [PMID 19924019]
Hackert T, Büchler MW, Werner J. Surgical options in the management of pancreatic cancer. Minerva Chir 2009; 64:465-476. [PMID 19859037] (FULL TEXT: http://www.minervamedica.it/en/download.php?cod=R06Y2009N05A0465)
House MG, Choti MA. Palliative therapy for pancreatic/biliary cancer. Surg Oncol Clin N Am 2004; 13:491-503. [PMID 15236731] (FULL TEXT: http://www.surgonc.theclinics.com/article/PIIS1055320704000353/fulltext)
Sohn TA, Lillemoe KD, Cameron JL, Huang JJ, Pitt HA, Yeo CJ. Surgical palliation of unresectable periampullary adenocarcinoma in the 1990s. J Am Coll Surg 1999; 188:658-666. [PMID 10359359] (FULL TEXT: http://www.journalacs.org/article/PIIS1072751599000496/fulltext)
World Health Organization. Cancer: Palliative care. WHO Programmes and Projects. (FULL TEXT: http://www.who.int/cancer/palliative/en)
Labori KJ, Hjermstad MJ, Wester T, Buanes T, Loge JH. Symptom profiles and palliative care in advanced pancreatic cancer-a prospective study. Support Care Cancer 2006; 14:1126-33. [PMID 16601947] (FULL TEXT: http://www.springerlink.com/content/d7p0776905322608/fulltext.html)
Uomo G, Gallucci F, Rabitti PG. Anorexia-cachexia syndrome in pancreatic cancer: recent development in research and management. JOP. J Pancreas (Online) 2006; 7:157-62. [PMID 16525199] (FULL TEXT: http://www.joplink.net/prev/200603/17.html)
Crippa S, Domínguez I, Rodríguez JR, Razo O, Thayer SP, Ryan DP, et al. Quality of life in pancreatic cancer: analysis by stage and treatment. J Gastrointest Surg 2008; 12:783-94. [PMID 18317851] (FULL TEXT: http://www.springerlink.com/content/0345676wh574652x/fulltext.html)
Maltoni M, Caraceni A, Brunelli C, Broeckaert B, Christakis N, Eychmueller S, et al. Prognostic factors in advanced cancer patients: evidence-based clinical recommendations--a study by the Steering Committee of the European Association for Palliative Care. J Clin Oncol 2005; 23:6240-8. [PMID 16135490] (FULL TEXT: http://jco.ascopubs.org/cgi/content/full/23/25/6240)
Nieveen van Dijkum EJ, Kuhlmann KF, Terwee CB, Obertop H, de Haes JC, Gouma DJ. Quality of life after curative or palliative surgical treatment of pancreatic and periampullary carcinoma. Br J Surg 2005; 92:471-7. [PMID 15672431] (FULL TEXT: http://www3.interscience.wiley.com/cgi-bin/fulltext/109876299/HTMLSTART)
Freitas D, Dos Santos Fernandes G, Hoff P, Cunha, JE. Medical management of pancreatic adenocarcinoma. Pancreatology 2009; 9:223-32. [PMID 194209891] (FULL TEXT: http://content.karger.com/produktedb/produkte.asp?typ=fulltext&file=000199433)
Mortenson MM, HO HS, Bold RJ. An analysis of cost and clinical outcome in palliation for advanced pancreatic cancer. Am J Surg 2005; 190:406-11. [PMID 16105527] (FULL TEXT: http://www.ajsfulltextonline.com/article/PIIS0002961005002254/fulltext)
Artifon EL, Sakai P, Cunha JE, Dupont A, Filho FM, Hondo FY, et al. Surgery or endoscopy for palliation of biliary obstruction due to metastatic pancreatic cancer. Am J Gastroenterol 2006; 101:735-42. [PMID 16968509] (FULL TEXT: http://www.nature.com/ajg/journal/v101/n9/full/ajg2006376a.html)
Ellis CM, Shenoy S, Litwin A, Soehnlein S, Gibbs JF. Effective endovascular stenting of malignant portal vein obstruction in pancreatic cancer. HPB Surg 2009; 2009:426-36. [PMID 19826629] (FULL TEXT: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760178/?tool=pubmed)
Yamakado K, Nakatsuka A, Tanaka N, Fujii A, Terada N, Takeda K. Malignant portal venous obstructions treated by stent placement: significant factors affecting patency. J Vasc Interv Radiol 2001; 12:1407-15. [PMID 11742015] (FULL TEXT: http://www.sciencedirect.com/science?_ob=MImg&_imagekey=B8CX3-4NH5DMK-9-J&_cdi=40075&_user=839424&_pii=S1051044307616996&_orig=browse&_coverDate=12%2F31%2F2001&_sk=999879987&view=c&wchp=dGLzVlz-zSkWb&md5=0368c21f47b0e608b917e54cc0253ce3&ie=/sdarticle.pdf)
Cunningham D, Chau I, Stocken DD, Valle JW, Smith D, Steward W, et al. Phase III randomized comparison of gemcitabine versus gemcitabine plus capecitabine in patients with advanced pancreatic cancer. J Clin Oncol 2009; 27:5513-8. [PMID 19858379] (FULL TEXT: http://jco.ascopubs.org/cgi/content/full/27/33/5513)
Yip D, Karapetis C, Strickland A, Steer CB, Goldstein D. WITHDRAWN: Chemotherapy and radiotherapy for inoperable advanced pancreatic cancer. Cochrane Database Syst Rev 2009; 3:CD002093. [PMID 19821291] (FULL TEXT: http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD002093/pdf_fs.html)
Gupta D, Rodeghier M, Grutsch JF, Lis CG. Predicting survival in advanced pancreatic cancer: The role of symptom clusters. 2010 ASCO Gastrointestinal Cancers Symposium. Abstract No. 265. (FULL TEXT: http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=72&abstractID=1662)
Price LH, Nguyen MB, Picozzi VJ, Kozarek RA. Portal vein thrombosis in pancreatic cancer: Natural history, risk factors, and implications for patient management. 2010 ASCO Gastrointestinal Cancers Symposium. Abstract No. 143. (FULL TEXT: http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=72&abstractID=1359)
Sanchetee SC. Thalidomide versus thalidomide with olanziapine and megastrol acetate in treatment of cachexia in gastrointestinal cancer: A randomized trial. 2010 ASCO Gastrointestinal Cancers Symposium. Abstract No. 209. (FULL TEXT: http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=72&abstractID=1288)
Subbiah S, Aldoss I, Gonsalves W, Tashi T, Al-Howaidi I, Silberstein PT. Adjuvant chemotherapy versus chemoradiation therapy in resectable pancreatic cancer: Retrospective analysis from the VA Central Cancer Registry (VACCR) database. 2010 ASCO Gastrointestinal Cancers Symposium. Abstract No. 230. (FULL TEXT: http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=72&abstractID=2402)
Aldoss I, Subbiah S, Gonsalves W, Fang X, Silberstein PT. Benefit of chemotherapy in very elderly patients (≥ 80) with metastatic pancreatic cancer: VA Central Cancer Registry (VACCR) database analysis. 2010 ASCO Gastrointestinal Cancers Symposium. Abstract No. 232. (FULL TEXT: http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=72&abstractID=2401)
Copyright (c) 2010 James Mark Lazenby, Muhammad Wasif Saif
This work is licensed under a Creative Commons Attribution 4.0 International License.
As a member of Publisher International Linking Association, PILA, iMedPub Group’s JOP follows the Creative Commons Attribution License and Scholars Open Access publishing policies. Journal of the Pancreas is the Council Contributor Member of Council of Science Editors (CSE) and following the CSE slogan Education, Ethics, and Evidence for Editors.